Cases of and hospitalizations for respiratory viruses, including Covid, the flu and RSV, continue rising across the US, and some health systems have begun returning to mask and limited-visitation policies as health officials warn that hospital capacity may become strained.
Vaccination rates for all three illnesses remain low, despite the efficacy of updated flu and Covid boosters and the entrance of new RSV vaccines for older and pregnant people.
The US Centers for Disease Control and Prevention (CDC) has urged providers to administer more vaccines in light of the possibility of “more severe disease and increased healthcare capacity strain” from respiratory illness, especially in the wake of holiday gatherings.
About 44% of adults have received flu shots this season, but less than half of that number – about 17% – of Americans eligible for the updated Covid shots have received them, with only one in three nursing home residents being up-to-date.
The updated Covid boosters protect well against currently circulating variants, according to early research.
Only 17% of adults 60 and up have received the new RSV vaccines, and Beyfortus, the new, highly effective treatment to prevent RSV among infants, has been very difficult to access.
“It’s really sad,” said Anita Patel, a critical care specialist at Children’s national hospital and an associate professor of pediatrics at the George Washington University school of medicine. “There was a dramatically reduced supply of Beyfortus, and a lot of people that needed it and wanted it couldn’t get it.”
RSV hospitalizations are almost double their peak in 2019 and still rising, though the rate so far is lower than last year’s surge.
“We are seeing quite a dramatic increase in flu,” said Patel. Doctor’s visits for flu-like illness, which can include the flu, Covid and other illnesses, are almost at the peak of the 2019-20 season. The CDC estimates flu has been responsible for 110,000 hospitalizations and 6,500 deaths thus far this season, with hospitalizations hitting the oldest and youngest Americans hardest.
Hospital admissions for Covid are up 20.4% from the previous week, and Covid deaths are up 12.5% in the same time period, with more than 1,600 people dying from Covid in the week ending 9 December, according to the last full data set from the CDC.
The concentrations of Covid detected in wastewater are the highest they have been since January 2022, when Omicron emerged and the CDC began tracking the virus in wastewater, according to the agency’s data.
Data from Biobot, another wastewater tracking service, shows wastewater concentrations at their second-highest level since the pandemic began. Experts caution that comparing wastewater surges is difficult because variants have different shedding speeds and longevity, and tools to measure wastewater composition have become more sensitive over time.
Waves of illness like these can have long-lasting health effects. More than 5% of American adults are currently experiencing long Covid symptoms, and 14.3% have ever experienced long Covid, according to the CDC.
Two studies published this week found that BA.2.86, the parent of the currently circulating JN.1 variant, may infect the lungs more effectively than previous Omicron variants. That doesn’t necessarily mean people will become sicker or have a greater risk of hospitalization or death, particularly since there is greater population immunity than at the start of the Omicron wave – only real-world data can tell that, researchers say.
So far, there is no evidence of increased severity, the CDC said in a statement.
The potential for increased lung infectivity is “alarming”, said Shan-Lu Liu, a virologist and co-director of the viruses and emerging pathogens program at the Ohio State University and one of the new studies’ co-authors. But “we still do not have strong clinical data to support that kind of surge in terms of hospitalizations and deaths”, he said.
“From the public health perspective, we need to be cautious, and as scientists, we need to continue to study the properties of the virus,” Liu said. When the virus mutates, which is more likely to happen the more cases there are, it could become more virulent or gain other concerning properties.
“People need to be vaccinated and get protection,” he said.
Hospitals in New York City, the San Francisco Bay Area, Los Angeles and Massachusetts have instituted mask policies to prevent the further spread of respiratory illnesses.
Pediatric hospital bed capacity now hovers around 73%, a rate similar to that during last winter’s “tripledemic”, and pediatric ICU beds are at 77% capacity, a rate higher than that of the same for adults.
“Now is your time to protect your kid, and we have the best tools in our arsenal to do that,” Patel said.
Getting vaccinated is one of the most important ways to be protected, as is wearing masks in public indoor places, improving ventilation, hand washing and staying home when you’re sick. Americans can also order four free Covid tests.
For many Americans, there have been challenges to accessing these precautions. “We continue to need free masks for low-income communities, free tests and free access to antiviral medications, most importantly Paxlovid, which is being underprescribed,” Julia Koehler, an associate professor of pediatrics at Harvard medical school and a clinical pediatric infectious disease specialist, said in an email.
“The pandemic is not over,” Koehler said, but added that public messages that the crisis has ended “has led many people to abandon protective measures they may have used last year”.
